Laserfiche WebLink
Permit No. <br /> APPLICATION FOR SANITATION PERMIT <br /> .` <br /> � (Complete in Duplicate) <br /> ._Date issued - -----�' <br /> Applica=ion is hereby made to the San{Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549, <br /> JOBADDRESS-AND LOCATION.-.;/__—e----wQ --------------------------------- =----------------------------------------------------- ---- --------------- <br /> Owner's Name' `� Ili -- --------- - - Phone '-G--y . <br /> _.. #. <br /> -= - <br /> F ----------------------------=------ ---------------------------------- ---------------------------------------; <br /> Address.-•___�� C /�-:__-._. ` •-----•- <br /> Contractor's Name _" = ------ -------------- Phone.. . (J-------------•-•---- <br /> Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court .[_ Motel ❑ Other ❑ <br /> _. .. <br /> / SQA /.ZU ` f <br /> Number of living units: _C_ __ rooms ___ _ Number of baths __�_ Lot size�l------------------------------------------------------------ <br /> Water Supply: 'Public system Cammun ty sya e,m-E] Private ❑ Depth to WaterTTabl '��_ ft,` ` <br /> Character of sail to a depth of,3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑. Clay Loam.[] i Clay ❑ Adobe ® Hardpan ❑ <br /> Previous Application Made: Yes ❑ No New C6nstruction: Yes W No ❑ :' I <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: - i <br /> , public seweris available within 100 feet. <br /> Se is Tank. p Distance from npearest1well__ ._.:_ -~ r J <br /> No septic tank or cesspool ermined if <br /> � � - ,,•„__-__r_Distance from^foundatiaq__--__.____ .__ . <br /> _Li uld depth--`-9Material-------------------------------------=----------• <br /> %7 No.,:of compartments-- ------ ---- Size- ------- :Capacity <br /> . --- <br /> } 6 ,___. nearesti <br /> p - ---I-:--.!-,A-+-_Len th of each line-___-_------�----------------��Vidth of trench--------t line_---__-------._.- <br /> _ - <br /> is o al Field: Di etance-from nearest 'Well <br /> . __� Distgance from foundation______________ Distance to to - Q <br /> - Number of lines __ _ <br /> Tpe os filter maferiaL ________-_)__._- -Depth of filter material:._.__.__ __. ____. fal length________------_ -------------------------- <br /> y <br /> p g --� -an -:.--- ar f l - -- 'Linin materia€.• .Size: D am��r��13 n * 7 ne' _ . <br /> { nearest lot line.____S_�_. <br /> See�a a Pit: Distance P+arestiwell-�l�_`_ Distance from foundation___}_ .. sstance to Dep};,----__v`�S'---------------- <br /> p Dining material <br /> Cesspool: DzeaDiam}eearest well==� ._--.=_ psttahce from.foundation _.---------.r­.­­-Lining <br /> Capacity---------------------_------gals. <br /> Privy: Distance from nearest well-ws--- ------------------------------------:._Distance from nea� st building_ _______.________.____-- ----------- <br /> El <br /> -------- <br /> 4. .a„-Distance to nearest lot line-----... n--- --------- n - - lill--------------------- -------------------- ---------- <br /> Remodeling <br /> �dh <br /> Remodeling and/ar repairing (describe):-.---- -�x---- -----------------�---- - --- - ---------•----��=-'�u"'�---- ------------ --,- ----------------..-._....---•-------- <br /> . t <br /> •--•---•----------------- ----- <br /> u <br /> ------------ - ------------------------------------- <br /> -------------------------------------------------------------------------------------------------------------------------- ---- <br /> -------------------------------------------l----------- ------------ -------=--------------------------- ------------------------ ---------------------------------------------------- <br /> 1 <br /> - --- -------------------- - <br /> 1 hereby certify that I have prepared this a lication'and that the work will be done in accordance with San Joaquin-County <br /> ordinances, State laws, and rules and regulations�f the San Joa quin„local,.Health District. ! <br /> (Signed e-A------ ----------0 ----- ----- .l --------- --------------------------------U10 <br /> er and/or Contractor <br /> ./�. M <br /> BY ----------- ' c” j --_-=-----•-- ITitle��I= --- �� <br /> {Plot,plan, showing size of lot, location of system 'relation to wells, buildings, etc., can be p� ced on reverse-side), <br /> FOR DEPARTMENT USE ONLY <br /> ---------------------- <br /> APPLICATION ACCEPTED BY------ ------------------- <br /> REVIEWED <br /> ------ _- • _tC- , DATE 'l � <br /> REVIEWED BY-----------------------------------r.-----:----- _: -�-- ----- ----------- <br /> BUILDING PERMIT ISSUED = ------------ ----=- = ,= DAT <br /> �,. <br /> t Alterations and/or recommendations:--------------- -----=--- ---------- -------- ---,...•-------------------• ------k-------- ---.._... ------- --•------- <br /> w - c ----------------------------------- ....................................... <br /> l <br /> tA� <br /> -•-----------------•---•-----------•------------------------------------------------------ ---------------------------=------- --------'---------- ---------------------------------------------- •------ <br /> ------------------- --------- ------------- -- ---- - -----------------------••--------- --- ••-- ----•-- <br /> = - ------------= 1 <br /> # 2 - t <br /> FINAL INSPECTION--BY:--- ...:. =- = � .... . .;.� _.... — `/` _ --- <br /> --�-� Date=_ � 1 <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street I 300 West Oak Street 132 Sycamore Street 814 North "C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> f <br /> ES---9-2M Revised W-2100 <br />